刘洪涛　王琼　朱龙柏

[摘 要] 目的：分析小儿脑积水脑室-腹腔分流术后并发症现状，探讨防治策略。方法：观察2011年5月—2014年5月收治随访3年以上的118例接受脑室-腹腔分流术治疗的脑积水患儿并发症发生情况。结果：118例患儿共出现并发症35例，发生率29.7%，感染多发生于术后3个月内，过度分流多发生于术后4个月～术后1年，分流管梗阻多发生于术后1年～术后3年，不同类型并发症的发生时间比较，差异有统计学意义（P<0.05）。患儿分流术后3个月内分流管生存率下降速率为4.2%/月，随着时间的延长，患儿分流管生存率下降速率逐渐减缓，平均分流管生存率下降速率为0.8%/月。年龄<3岁患儿感染发生率显著高于年龄≥3岁患儿，术后体位频繁变化患儿过度分流发生率显著高于术后体位未频繁变化患儿，差异有统计学意义（P<0.05）。结论：小儿脑积水脑室-腹腔分流术后并发症发生风险较高且不同并发症的发生时间有所差异，根据患儿实际状态，于术后不同时期实施相应防治方案，以降低并发症风险。

[关键词] 小儿；脑积水；脑室-腹腔分流术；并发症

中图分类号：R720.5 文献标识码：B 文章编号：2095-5200（2016）04-038-03

DOI：10.11876/mimt201604015

Analysis of The Postoperative Complications Of Ventriculo-peritoneal Shunt In Pediatric Hydrocephalus LIU Hongtao1，WANG Qiong1，ZHU Longbai2. （1.Department of paediatrics；2. Department of general surgery，Huaguo Hospital of Dongfeng company，Shiyan 442000，China）

[Abstract] Objective： To analyse the postoperative complications of ventriculo-peritoneal shunt in pediatric hydrocephalus and explore prevention and control strategies. Methods： Observed the postoperative complications of 118 cases of children patients with hydrocephalus admitted from May 2011 to May 2014 who had been followed up for more than 3 years. Results： 35 cases of postoperative complications were found out with an incidence rate of 29.7%. Most of the infections occurred within the next 3 months， of excessive shunt within the next 4 to 12 months， while of shunt tube obstructions within the next 1 to 3 years. The differences of the incidence time from different complications had statistical significance（P<0.05）. The downward velocity of shunt tubes survival rate within 3 months after the operation was 4.2% per month. As time went on， the downward velocity gradually slowed down and the average velocity of shunt tubes survival rate was 0.8% per month. The infection rate of children patients under 3 was obviously higher than that of children more than 3 years old. The excessive shunt rate of of children with frequent postoperative position changes was significantly higher than that of children with unfrequent position changes. The difference had statistical significance（P<0.05）. Conclusion： The postoperative complications of ventriculo-peritoneal shunt in pediatric hydrocephalus had a high incidence risk and the incidence time of different complications varied. Targeted measures should be adopted concerning the conditions of patients among different postoperative periods to reduce the risk of complications.

[Key words] pediatric；hydrocephalus；ventriculo-peritoneal shunt；complications

脑积水多由脉络丛脑脊液产生过多、脑脊液吸收障碍或脑积液循环受阻引发的脑脊液吸收、分泌及循环障碍导致[1]。侧脑室腹腔分流术、侧脑室心房分流术、侧脑室脑池分流术是临床治疗脑积水的主要分流方案，其中，脑室-腹腔分流术是临床最常用方案，治疗效果确切[2]。但文献报道，脑积水脑室-腹腔分流术后，患儿1年内并发症发生率在40%以上，是导致患儿术后残疾甚至死亡的重要原因[3]。为明确小儿脑积水脑室-腹腔分流术后并发症发生原因，对我院2011年—2014年收治的118例接受脑室-腹腔分流术治疗的脑积水患儿进行回顾性分析。

1 资料与方法

1.1 一般资料

对我院2011年5月—2014年5月收治的随访时间达到3年的118例接受脑室-腹腔分流术治疗的脑积水[4]患儿进行回顾性分析。118例患儿中，男67例，女51例，年龄3个月～14岁，平均（3.65±1.83）岁，病因：先天性脑积水71例，其他原因所致脑积水47例，临床表现：颅围增大80例，落日征37例，头皮静脉怒张25例，四肢肌张力增高7例，其他（颅压增高、头痛、呕吐、乳头水肿等）42例。……